The Online World Is a Double-Edged Sword for Youth Mental Health

— Here’s how to support young patients and their parents

by Tiffany Munzer, MD

May 14, 2024

John* is a 12-year-old boy with autism who was presenting to our clinic in the midst of a mental health crisis, with suicidal thoughts and school avoidance. Given the bullying he faced, attending school was causing him so much anxiety that he stopped going. Socially, he was finding some connection with his peers through online board games. His parents were incredibly responsive and sensitive. They co-created rules around digital media that prioritized both online and offline activities that supported his mental well-being. They encouraged him to go outside every day and participate in online classes to expose him to learning opportunities. Ultimately, they enrolled him in an in-person school with a more nuanced understanding of youth with neurodiversity. His parents also addressed his mental health crisis with appropriate therapy and medications, which were key to his recovery.

In my clinical work with families, I have witnessed both the benefits and drawbacks of digital media for youth well-being. John’s example offers a positive anecdote: he was well-supported by his parents and they were using digital media to promote his connection with peers.

Unfortunately, not all online experiences are positive. But clinicians and parents are well-positioned to help kids make the most out of digital media.

Kids today are inheriting a world where their opportunities are corroded by inequity, racism, global conflict, and climate change. It is not surprising that youth mental well-being is declining in this context. Understanding how these stressors shape each family’s unique life experiences can help clinicians identify families’ emotional bandwidth to talk about digital media. Therefore, to better support families, it is important to understand both the benefits and drawbacks of digital media and how they might fit in with these stressors.

Let’s start with the benefits of digital media. I am consistently struck by the savviness, thoughtfulness, and resilience of my young patients. They are not taking a backseat when faced with adversity. They are taking to social media for civil engagement to create impactful change. They are creating resilient communities where they find meaningful connection. Many of my patients have found digital spaces to be a welcome place for LGBTQ youth to gather when physical spaces may not provide belonging or even safety. They are using digital media to create, learn, and explore in ways we could not imagine even 10 years ago.

The downsides to social media can be found in the problematic designs of the technology itself. These design elements often do not account for the youth perspective or needs. Persuasive design is routinely leveraged and paired with algorithms that funnel highly-individualized content to users. Online platforms are filled with violent, inappropriate, or commercialized content. As such, there is a critical role for digital media companies to create safer and less monetized products that help kids thrive. Until digital spaces are better designed for young people, it remains crucial for parents to understand what their adolescents are viewing online.

Indeed, there is abundant research that finds that parents serve an impactful role in shaping youth digital experiences. Recent work has pointed to three key parent factors that help adolescents flourish online. First, a parent’s support of a youth’s autonomy — where parents actively converse about what their kids are seeing online — can help create a soft landing for young people in case they see negative content. Second, a parent’s own digital literacy and savviness can help their child navigate digital media in a positive way. Third, a parent’s ability to set consistent boundaries around digital media can help youth feel in control of their digital media opportunities.

As a clinician, there are many ways that you can consider supporting parents and young patients in navigating digital and social media. The 5 Cs of Media Use from the Center of Excellence on Social Media and Youth Mental Health and the American Academy of Pediatrics (AAP) provides a helpful framework. AAP has also developed a family media plan with ideas and talking points to help point families toward positive online experiences.

These helpful approaches for parents are summarized below:

Child: Each individual has unique characteristics and personality that might influence how they use digital media. For instance, some children might be more susceptible to the gamified and persuasive designs that keep users online for long periods of time. Other children may not have as much difficulty with transitioning away from these designs. Understanding who the child is can help the parent set tailored and appropriate boundaries and limits with digital media.

Content: Make sure youth are viewing and engaging with positive online content. Organizations such as Common Sense Media offer many ideas around the right content to engage with. Avoid content with hidden commercials or advertising.

Calm: Think about how a device might be used to calm negative feelings. Help build skills outside of digital devices for kids to use when they are feeling stressed or overwhelmed.

Crowding out: Make sure digital opportunities are not crowding out other opportunities for education, sleep, social connection, and physical activity. Simple ways to help promote sleep include charging devices outside of the bedroom and avoiding screen devices an hour before bedtime. Establish device-free spaces and time, such as during meals, in order to set aside times to connect as a family.

Communication: Create a safe space for teens to come to you — as a healthcare professional or a parent — with what is on their mind and what they are seeing on digital media. Often this requires listening without judgment and asking open-ended questions. Help kids understand that nothing is truly private online and that they are leaving behind a digital footprint that could have unintended consequences.

Because of how digital spaces are currently designed, it can be challenging for families and youth to navigate online spaces and establish clear rules and boundaries. But with the right tools, clinicians and parents have the power to support youth in digital spaces so they can thrive and make the most out of online opportunities.

*Patient name has been changed for privacy.

Tiffany Munzer, MD, is a developmental behavioral pediatrician and clinical assistant professor with the University of Michigan Medical School and Health System in Ann Arbor. She is also a member of the American Academy of Pediatrics Council on Communications and Media executive committee.

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